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Max health worries

Jenphilly

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I know, it's been forever since I disappeared and unfortunately it's a health crisis with Max that reminded me you never know when you need a network of fellow crazy parrot parents! For the many members I've never chatted with, Max is a now 34 year old blue and gold macaw that decided 9 years ago that I was his new mom. I never wanted one of the large birds and I've always joked I'm not a macaw person, I'm a Max person, no matter what form he came in, he is no doubt my perfect parrot match

And apologies to everyone new to reading my novels... I babble! There you've been warned!

So reason I'm here.... we are in midst of testing and diagnosis, but things are looking more and more to Max having liver disease of some type. I'm here hoping someone has some experience to share of living with liver disease in your large parrot. Diet changes or restrictions that helped to control or stabilize liver disease? Medications that were effective? Meds that you'd never consider or suggest again? We don't have all answers to the specific what and why, but trying to catch up on new treatments that have shown promise.

I'll post the details as a response below, if anyone wants to read what we've done and know so far.

Thank you to anyone that can share their experience!
 

Jenphilly

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This is the start of things on Tuesday....

Well it's been a long evening... Max went into the Vets for what we thought was his winter dry nares (nose)... every year he is prone to dry crusty nose, but usually steam baths solve the problem. But he's been breathing a bit heavy like he's really stuffed up (but no sneeze or discharge). Physical exam the vet found fluid in his lower abdomen, she showed me and it felt like a water balloon. They did a quick ultrasound, confirmed with me he's really a DNA sexed male (he is). Plan was made to draw some of the fluid (too much and the delicate air sac structures could collapse). She pulled 120 cc of fluid, and yep that is 'some', she was then able to safely do x-rays. And finally blood was drawn. Blood and fluid is going out for testing, but even without all the answers, the situation is not great. Vet said x-rays look like arteries to the heart may be enlarged.... Max came home with me, but only because they don't offer critical night care.

He perked up alot when we got home. I was able to easily get a dose of Lasix in him and he ate with quite the appetite. I have his travel cage next to the bed so he's with us tonight.

I've reached out to a full service speciality animal hospital and expect we will have a consultation with both vet offices and the new place will receive x-rays in morning. Not sure if we will be heading to Jersey with him tomorrow or if the new vet will want to get all the lab work back and keep him home as long as he's stable and comfortable.

It's gonna be a tough month....

Max pics tonight and the very painful first bill.
 

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Jenphilly

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And Wednesday update.... I imclude the video that made me realize we missed the tiniest clues like he wasn't doing his deep belly laughs.... when he laughed, realized I couldn't recall the last time he laughed like that....

Thank you everyone that sent will wishes and thoughts for Max. He's been stable today, still breathing easy. Working on getting his xrays and ultrasound files to a long trusted avian vet we've known about 15 years, she's an hour drive since we moved to Lehigh, but expect tomorrow we will have the imaging on CD and at least primarily culture and blood results in hand. I plan to drive down to see Dr Knight (aka Dr Mac) tomorrow for her review of testing so far, her own exam and I'm hopeful she will proceed with removing additional fluid to give him some breathing room (litetally) until all labs are finalized hopefully by Monday.

Keep sending positive thoughts and energy. I'm remaining hopeful that we've caught this early enough that even if it's worst case scenario of heart or liver, he's strong and doing well enough that we can at least maintain and prevent (or slow) progression. He's on lasix right now and seems to be responding well to that.... he loves veggies like cucumbers and fruits like grapes, melon and oranges that are high in water content, so great to balance the risk of dehydration from lasix. Added baby bird formula in his diet to bump up calorie intake, that's been hit and miss, depending on how I present it to the spoiled blue brat.

Thank you again for all the positivity and love for the problem child. He's having a sleep over with us again tonight just so I can hear if he starts struggling. Byron said once everyone is settled, Max seems to like having bunkmates! Video of the long good night tonight

Now if I recall how you post video links!

 

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Jenphilly

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Latest update today.... including the lab results we have, and again I'm having that blood rerun for a more realistic check on that CPK....

Max update... he's remaining stable and still looks and acts like he's fine. Birds are notorious for hiding illness but now that we know something serious is going on, we still are not seeing any subtle hints of pain, which hopefully is good news that we caught this early. More test results back today, and mixed results.... great news no cancer cells, so very positive, but bad news, not an infection (which was best case hopes).

We went to see our old longtime avian vet (she's an hour from us now, but happy to make that run to have her head up Max's care)... she said nothing definitive yet with some results still missing, but she feels pretty comfortable it's not cardiac. She was able to pull a very small amount of fluid from Max's abdomen yesterday and sent that out for cytology. Good news, there was only a small amount of fluid there, so thankfully he's not filling up with fluid real quick.

The local vet (not an avian specialist but she has alot of parrot clients) called today and the lab screwed up prepping Max's blood for the CBC panel, so they needed him back in to draw more. I asked them to rerun some of the blood because the results were likely skewed by them drawing blood at the end of the marathon visit Tuesday evening.... Max's CPK level is really high, but CPK spikes with stress and muscle 'injury', a parrot struggling and flapping during routine exam can spike CPK.... Max was restrained multiple times along with the abdomen fluid drain then an ultrasound then being knocked out for an xray and then the blood draw.... and his protein level was low, but we were there about 645 til after 930, and again blood was last thing done. So, I asked them to rerun to try to get a more accurate result. Fingers crossed!

Waiting on the new blood and more fluid analysis, but remaining hopeful that he is still fairly young (macaws average human life expectancy), and he's only 34.... so age, overall health and how strong he is, all giving hope that we can treat and/or maintain his condition so he has another 20 or 30 years with us, at least! Fingers crossed, prayers, energy or whatever you believe in are welcome for the blue brat!

Hugs and love to Mom Kathy and Auntie Amanda... they sent a care package for the big blue brat (and humans, we all love the mango!!!). Somehow Max knew there must have been nuts in the package, I was surprised he passed up on the orange slices (he loved those last time), but he searched the bags til he found an almond.... fair enough, we're eating the mango!!

Hopefully it's a quiet weekend and Monday we have more results in. At the moment, next expected step is a full cardiac and abdomen ultrasound to try to pinpoint where the fluid is coming from, even if we know why, there are still a few possible wheres. I have a call in to a large facility with ultrasound and other imaging options, Mt Laurel over in NJ. I expect that's our next stop on the diagnosis rollercoaster...
 

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April

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I'll tag @Macawnutz for you she has lots of Macaw experience and is very knowledgeable about what to do and ask for at the vet.



I'm so sorry that Max is dealing with this. My Greenie had Fatty Liver disease and she was put on milk Thistle and urosidol(sp) and that combo did seem to help her quite a bit. Wishing the best for you and Max.
 

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I hope they can find what's wrong & get him on meds/etc. to help him. Hopefully it's not serious. I was also going to suggest milk thistle.

The video you posted is blank, totally black is all I see. I noticed something in the pics you posted....his face feathers. In some pics they look normal, but in the last few they look very sparse, thin. Not sure if this is an issue or not.
 

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Nice to see you again @Jenphilly , although I wish the circumstances were better.
I hope they can get Max on the proper meds and the tests come back in your favour.
Sending positive thoughts :)
 

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I hope your vets can pinpoint the origin of the fluid. I hope this weekend is peaceful and restful for you both in preparation for the next diagnostic round coming up.
 

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Oh Jen, I've been reading about it on Facebook and sending our love to Max.

Hands down start the milk thistle. The liver is very resilient and capable of repairing itself so be optimistic. Mary Lynn would tell you to keep him on the Lasix. She had great success with that medication.
Have you looked at previous CPK levels? Does he usually run high enough to think the visit itself could have caused it? Max is three times higher than normal. My experience with that would be a detailed cardiac exam before considering stress. The new bloodwork will tell you a lot more.

I am going to tag someone though. @Milo
 

Jenphilly

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I hope they can find what's wrong & get him on meds/etc. to help him. Hopefully it's not serious. I was also going to suggest milk thistle.

The video you posted is blank, totally black is all I see. I noticed something in the pics you posted....his face feathers. In some pics they look normal, but in the last few they look very sparse, thin. Not sure if this is an issue or not.

The video is audio of him... I had him next to the bed for a few nights. More a comfort to me than him.
 

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I just took a quick read over things...

I'm so glad that Max is doing better and not accumulating more fluid!

The CK may be real. It's a very high number but as you know a lot can depend on what happened in the exam and what was causing the issue to begin with. If this is something chronic that's been creeping up on him his body could just be responding to that, and in addition to the diagnostics that's a lot for his body to go through! There were inflammatory cells in the fluid sample so that could have also contributed to it. If the fluid is slow to come back and he's been doing well at home the number may well come down but that doesn't mean that the original number wasn't real.

Definitely stay on meds until the vets tell you to discontinue, and I would talk to them before starting anything, milk thistle won't hurt but if he's iffy about meds adding in something else can just add more stress. His liver values on his chems looked like they were normal, the radiographs on the VD (where he's laying on his back) are challenging to interpret in terms of the heart/liver silhouette which can help tell us if the liver or heart is enlarged.

It looks like the uric acid is just on the high end, and combined with the low albumin (blood protein) the docs may recommend making changes based on that.

I saw that you're going to a specialty hospital and I think that's a really great next option, in these cases we typically recommend a CT scan with contrast to really get a good look at everything. It will require heavy sedation and possibly anesthesia to get good, diagnostic images. I'm not sure of the protocols where you're going but I'm happy to share what the process typically involves. It sounds much more scary than it actually is.

Macaws can pretty commonly get atherosclerosis, which is a vascular disease where plaques form in the great vessels and start to obstruct blood flow. The heart function can be normal but it just has to work harder to get blood places. It can contribute to fluid accumulation in the coelom (their abdomen) and we usually assume that older macaws usually have some extent of atherosclerosis just like humans. Max doesn't sound like a typical presentation though, but if he does have advanced imaging it wouldn't be abnormal if they found it even if it's not causing symptoms.

Right now, unless directed otherwise by your vet, don't start to add things that are full of fat or calorically dense to his diet, if he does have liver or kidney disease extra protein will be very hard on the kidneys and more fats in his diet will be hard on his liver. Limiting nut intake and if he does get them offer walnuts or almonds, but maybe 1-2 per day maximum. If Max is maintaining weight well without it, I would stop the baby bird food. Switching fruits to things like berries are better than grapes but I know the kids can be picky!

I really hope you're able to get some answers soon, it's really awful when the kids are sick. Wishing the best for you and Max!
 

Jenphilly

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I just took a quick read over things...

I'm so glad that Max is doing better and not accumulating more fluid!

The CK may be real. It's a very high number but as you know a lot can depend on what happened in the exam and what was causing the issue to begin with. If this is something chronic that's been creeping up on him his body could just be responding to that, and in addition to the diagnostics that's a lot for his body to go through! There were inflammatory cells in the fluid sample so that could have also contributed to it. If the fluid is slow to come back and he's been doing well at home the number may well come down but that doesn't mean that the original number wasn't real.

Definitely stay on meds until the vets tell you to discontinue, and I would talk to them before starting anything, milk thistle won't hurt but if he's iffy about meds adding in something else can just add more stress. His liver values on his chems looked like they were normal, the radiographs on the VD (where he's laying on his back) are challenging to interpret in terms of the heart/liver silhouette which can help tell us if the liver or heart is enlarged.

It looks like the uric acid is just on the high end, and combined with the low albumin (blood protein) the docs may recommend making changes based on that.

I saw that you're going to a specialty hospital and I think that's a really great next option, in these cases we typically recommend a CT scan with contrast to really get a good look at everything. It will require heavy sedation and possibly anesthesia to get good, diagnostic images. I'm not sure of the protocols where you're going but I'm happy to share what the process typically involves. It sounds much more scary than it actually is.

Macaws can pretty commonly get atherosclerosis, which is a vascular disease where plaques form in the great vessels and start to obstruct blood flow. The heart function can be normal but it just has to work harder to get blood places. It can contribute to fluid accumulation in the coelom (their abdomen) and we usually assume that older macaws usually have some extent of atherosclerosis just like humans. Max doesn't sound like a typical presentation though, but if he does have advanced imaging it wouldn't be abnormal if they found it even if it's not causing symptoms.

Right now, unless directed otherwise by your vet, don't start to add things that are full of fat or calorically dense to his diet, if he does have liver or kidney disease extra protein will be very hard on the kidneys and more fats in his diet will be hard on his liver. Limiting nut intake and if he does get them offer walnuts or almonds, but maybe 1-2 per day maximum. If Max is maintaining weight well without it, I would stop the baby bird food. Switching fruits to things like berries are better than grapes but I know the kids can be picky!

I really hope you're able to get some answers soon, it's really awful when the kids are sick. Wishing the best for you and Max!
Thank you for your time and sharing your experience!

I'm not adding anything, unless Dr Mac, directs at this point.. Apologies if i was not clear that this is reconnaissance, right now this is all homework to see how others have successfully managed liver disease IF we end up with a liver diagnosis.

First vet suggested baby food because once fluid was removed, he technically had lost weight. Ironically I seldom feed grapes, feed very little sugar/ fruits period, the grapes were just added hydration, as we all know, parrots naturally obtain most of their hydration from veggies/fruits/plants. There was more worry about hydration with lasix. Dr Mac wanted the lasix stopped, depending on what we are actually dealing with, she has seen ongoing lasix do as much damage as good. She suggested Harrison High potency mash be used for now to help with easily absorbed protein, but that is also a level that a double check was wanted.

His past CPK values were normal tending toward the high end, Max is very nervous and stressed anytime he's outside the home, always joked he's a nervous nelly, always panicking Im leaving him somewhere. I cannot find his oldest blood work, but he is anxious, he arrived with some weird OCD mannerisms from his previous home, and he's always fretting when he goes to the vet, his behavior is typical of abandonment anxiety. He did have bruises on his legs/feet and slight on face from his struggles at the Tuesday marathon vet visit. My vet nor I are dismissing any lab results, but the reality, nearly 3 hours of high stress and multiple restraining is very likely a factor how high the results came back, not expecting normal, but just a bit more reliable for where things are.

Still trying to get a confirmed spot at the Mt Laurel facility for the next imaging series, was hoping we would be in Monday or Tuesday.... I keep saying I'm glad he's not falling over waiting for this scan! .Wish I could find a smaller vet group with avian ultrasound, these large groups have been horrible with communication.
 

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Do you have a university near? When I need Avian CT it's either U of WI or U of IL. Wisconsin is an easier trip for me but I'd love to go to U of IL.. For comfort reasons. ;)
 

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Thank you for your time and sharing your experience!

I'm not adding anything, unless Dr Mac, directs at this point.. Apologies if i was not clear that this is reconnaissance, right now this is all homework to see how others have successfully managed liver disease IF we end up with a liver diagnosis.

First vet suggested baby food because once fluid was removed, he technically had lost weight. Ironically I seldom feed grapes, feed very little sugar/ fruits period, the grapes were just added hydration, as we all know, parrots naturally obtain most of their hydration from veggies/fruits/plants. There was more worry about hydration with lasix. Dr Mac wanted the lasix stopped, depending on what we are actually dealing with, she has seen ongoing lasix do as much damage as good. She suggested Harrison High potency mash be used for now to help with easily absorbed protein, but that is also a level that a double check was wanted.

His past CPK values were normal tending toward the high end, Max is very nervous and stressed anytime he's outside the home, always joked he's a nervous nelly, always panicking Im leaving him somewhere. I cannot find his oldest blood work, but he is anxious, he arrived with some weird OCD mannerisms from his previous home, and he's always fretting when he goes to the vet, his behavior is typical of abandonment anxiety. He did have bruises on his legs/feet and slight on face from his struggles at the Tuesday marathon vet visit. My vet nor I are dismissing any lab results, but the reality, nearly 3 hours of high stress and multiple restraining is very likely a factor how high the results came back, not expecting normal, but just a bit more reliable for where things are.

Still trying to get a confirmed spot at the Mt Laurel facility for the next imaging series, was hoping we would be in Monday or Tuesday.... I keep saying I'm glad he's not falling over waiting for this scan! .Wish I could find a smaller vet group with avian ultrasound, these large groups have been horrible with communication.
Gotcha! No worries, I'm still caffeinating this morning so I may have mistyped as well!

Makes total sense with the Lasix, and since the fluid isn't accumulating quickly that seems like a reasonable approach. It can be very hard on the kidneys to be on a diuretic like that for longer periods of time. The protein makes sense, high potency in an older macaw does make me a little nervous because of the fat and protein content but as a temporary bandaid that makes sense. Low blood protein can cause effusion because the protein helps keep the plasma portion of the blood in the vessels. When blood protein is low it causes the vessels to become "leaky" and then fluid doesn't stay where it's supposed to. Low blood protein can be caused by a couple different things so it's good that you're going for further testing to confirm.

If he's very stressed at the vets you may want to consider asking about sedation for future visits. Did they sedate him for his exam and diagnostics when you took him in? They can give him a controlled substance in the clinic but there are oral meds that you could give him at home that would take the edge off. Again I know that's something that sounds scary but they're quite safe and can really make a difference! We see it a lot where birds get more and more stressed over the years for vet visits and drugs are one of the best tools that we have to help make them more comfortable in a practice!
 

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Gotcha! No worries, I'm still caffeinating this morning so I may have mistyped as well!

Makes total sense with the Lasix, and since the fluid isn't accumulating quickly that seems like a reasonable approach. It can be very hard on the kidneys to be on a diuretic like that for longer periods of time. The protein makes sense, high potency in an older macaw does make me a little nervous because of the fat and protein content but as a temporary bandaid that makes sense. Low blood protein can cause effusion because the protein helps keep the plasma portion of the blood in the vessels. When blood protein is low it causes the vessels to become "leaky" and then fluid doesn't stay where it's supposed to. Low blood protein can be caused by a couple different things so it's good that you're going for further testing to confirm.

If he's very stressed at the vets you may want to consider asking about sedation for future visits. Did they sedate him for his exam and diagnostics when you took him in? They can give him a controlled substance in the clinic but there are oral meds that you could give him at home that would take the edge off. Again I know that's something that sounds scary but they're quite safe and can really make a difference! We see it a lot where birds get more and more stressed over the years for vet visits and drugs are one of the best tools that we have to help make them more comfortable in a practice!

They only knocked him out for the xray.... imagine what that image would have looked like with a squirmy angry blue dinosaur! :p my vet laughed at their ultrasound, even joked she hoped they didn't charge me for that, it was blurry from him fighting them.

I'm laughing at the coffee... you're up early without caffeine and I was posting half middle of the night, no restful sleep for 3rd night.

Max did sleep in his own bed last night.... we found him sitting on the laundry basket outside of his bedroom last night when it was bedtime, I took that as his clear request to sleep in his bedroom and not ours.... is it overkill I'm thinking I need a baby monitor?? Yeah that is for mom comfort,not Max comfort!! :D:rofl::goodnight2:
 

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Do you have a university near? When I need Avian CT it's either U of WI or U of IL. Wisconsin is an easier trip for me but I'd love to go to U of IL.. For comfort reasons. ;)

Philly is only one I know for avian.... but good thought, I'll do some homework... off to chat with Uncle Google!

We have some amazing large vet facilities but their level of care, concern and communication has sucked big :dance4: I've contacted Northstar 3 times with no response.
 

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Believe it or not there are practices out there that don't use sedation or anesthesia for their radiographs.... terrible image quality and usually end up with people hands in them which is a HUGE safety concern! The images we've had sent to us from various places are pretty crazy. It's also tough sometimes to tactfully explain that we have to retake rads because the ones sent aren't diagnostic because of poor positioning... but that's getting away from the point here

It can't hurt to talk to them about some mild sedation for the exams, it can help make the CBC portion easier to interpret as well since stress can affect white blood cell counts in all bird but we see some pretty amazing elevations in macaws when they get stressed for the exam. It's also nice because one of the drugs is reversible and also has an amnesic effect so they don't remember the stressful event! The other is out of their system in a couple hours so they get a pretty nice mellow from it that can also last the car ride home :)

Poor guy just wanted to sleep in his own room! If it helps you sleep as well a baby monitor isn't a bad idea, you need rest too!
 

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Philly is only one I know for avian.... but good thought, I'll do some homework... off to chat with Uncle Google!

We have some amazing large vet facilities but their level of care, concern and communication has sucked big :dance4: I've contacted Northstar 3 times with no response.
Not making excuses for different hospitals.... but I want to gently add that veterinary hospitals are still slammed right now and the majority are severely understaffed due to losses from burnout and a lack of people entering the field to fill those jobs. Try not to take it as a reflection of the staff and how much they care about patients. You can also have your vet reach out to them for a referral and see if they need that first? The good thing is that Max is stable and has a good vet to help manage him while you figure out the referral process.

Again I don't know the situations at these specific hospitals but I can tell you where I am the caseload is enormous and sometimes there just aren't enough hours in the day or people on the clinic floor and we have to choose between going through voicemails and managing patients and appointments that are in the hospital. It's tremendously frustrating and unfortunately there's not a good solution to the problem... and it's hard when you're trying just to get scheduled and feel like you're hitting a wall. I promise that they do care.
 

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Not making excuses for different hospitals.... but I want to gently add that veterinary hospitals are still slammed right now and the majority are severely understaffed due to losses from burnout and a lack of people entering the field to fill those jobs. Try not to take it as a reflection of the staff and how much they care about patients. You can also have your vet reach out to them for a referral and see if they need that first? The good thing is that Max is stable and has a good vet to help manage him while you figure out the referral process.

Again I don't know the situations at these specific hospitals but I can tell you where I am the caseload is enormous and sometimes there just aren't enough hours in the day or people on the clinic floor and we have to choose between going through voicemails and managing patients and appointments that are in the hospital. It's tremendously frustrating and unfortunately there's not a good solution to the problem... and it's hard when you're trying just to get scheduled and feel like you're hitting a wall. I promise that they do care.
Absolutely agree my clinic is constantly slammed and it just doesn't stop
 

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Nice to have you back, although I am sorry it's under these circumstances. I hope Max will be okay.
 
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